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ACL Prehab

ACL Prehab: Why Is It Important?

Regardless if you decided to have surgery or not, the next step is non-negotiable: prehab! Prehab is referred to as rehab prior to surgery or rehab to prevent any future injuries. If you want to learn more about ACL injuries check out this video

“Why Bother With Prehab if I’m Going to Have Surgery Anyways”?

One of the most important reasons why you need to start doing p/rehab as soon as possible following an ACL injury is to help figure out if you need surgery or not! The biggest sign, or tell, if you should consider having surgery is moments of knee instability, or the knee giving out. In other words, your feel like your knee feels weak or gives out when walking, going up and down stairs, squatting, or doing other daily activities. If you want to learn more about whether or not you should have ACL surgery check out this video and or previous blog article that goes into more detail about this topic.

Another reason prehab is important is because research demonstrates better outcomes for individuals who did prehab in comparison to those who did not. Some of those outcomes include less pain, patient-reported better function, higher percentage of returning to prior level of function, and confidence in the knee. Furthermore, we have seen in our practice that athletes who did nothing following their ACL tear until after surgery, had a more challenging rehab meeting milestones. The athletes who we worked with prior to surgery, had a quicker and easier rehab meeting milestones and progressing versus their counterparts. If you are deciding to have surgery, there are a couple of goals we like to achieve before the athlete goes into the operating room.

1. Minimize Swelling

This is one of the most important goals to achieve before you have surgery. Swelling is a normal healing process of your body, but if it is persistent, your body is telling you something is wrong. Therefore, before going into surgery we want to have a calm knee, meaning the knee should have very minimal swelling. We have seen athletes that had swelling prior to surgery, have longer lasting swelling issues following surgery. Furthermore, less swelling will allow you to have more success in achieving the other goals.

2. Regain As Much Range of Motion As Possible

This is another huge goal before having surgery; however it can be harder to achieve because of the trauma that happened to the knee and persistent swelling. When we talk about regaining full range of motion, we want to have good extension and also good flexion range of motion. Good knee extension would be as close to full extension as possible, and good knee flexion is 120 degrees or being able to get full rotations on a bike. The longer you wait to work on your range of motion following your injury, the stiffer your knee will get.

3. Improve You Muscle Motor Control & Strength

Finally, muscle control and strength plays a huge role in recovery because it allows you to move properly and perform daily activities. Our biggest advice is that the stronger you go into surgery, the easier the recovery. However, with that being said, spend most of your time on the first two goals then progress to this goal. The concern is that right after surgery, you will have muscle atrophy, or muscle loss. This happens because of the trauma from the surgery and disuse, which can be magnified if you don’t do any strengthening prior to surgery. 

Therefore, if you are already losing muscle prior to surgery, surgery will compound your muscle weakness. Also it is a good time to get some baseline testing with your physical therapist because during that time the opposite leg can be used as a good baseline to get to with the opposite leg that is having surgery. Some of the muscles we encourage athletes to work on are the quadriceps, hamstrings, calves and glutes.


To recap, the most important thing you should be doing following your ACL injury is prehab! It provides feedback to yourself and your healthcare provider if you need surgery and what you need to be doing to improve your outcomes. If surgery is the route, our checklist to have before surgery is minimal/no swelling, knee extension to 0 degrees, knee flexion to 120 degrees and start doing some muscle activation and strengthening exercises.

The Basketball Doctors - Gabriel Ignacio Physical Therapist

Dr. Gabriel Ignacio PT, DPT, OCS, TPI

The Basketball Doctors - Marco Lopez Physical Therapist

Dr. Marco Lopez PT, DPT, CSCS

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